How does the cost of medication affect treatment selection for psoriasis?

Updated: Nov 20, 2020
  • Author: Jacquiline Habashy, DO, MSc; Chief Editor: William D James, MD  more...
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Answer

See above Treatment of Skin Lesions for a discussion on different treatment options. All newer medications, especially the biologic therapies, are extremely expensive, with cash prices ranging from $30,000 per year to over $80,000 per year. Other medications, topical and systemic, that have been available for decades have been subjected to regular price increases, which, while keeping them less expensive than a newer biologic agent, has still resulted in them being very expensive. This usually includes generic medications, when generics are available.

Industry communications reveal that the list cost of a new medication has little to do with the cost of research and manufacturing expenses, but more to do with target income goals and considerations of what the market will bear. For this reason, most insurance plans do not do blanket approval of any and all FDA-approved medications and will often require a staged approval process, where a patient will have to have been unresponsive or have had significant adverse effects to less expensive medications before more expensive treatments are considered. This is even more problematic when there are attempts to do off-label psoriasis treatment using medications indicated for other inflammatory and arthritic conditions. Such use, even if supported by the scientific literature, is often be branded "experimental", and insurance coverage may be difficult or impossible to obtain.

Difficulty in reliably obtaining, storing, and using some of these newer medications may explain why the biologics seem to be less efficacious in patients with lower socioeconomic status. [52]


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